It is of obvious importance that optometrists know about the various modern local sub-specialities in ophthalmology. Accurate referral to the correct sub-specialist is in the patient’s best interest in terms of the final outcome of a procedure. It is also the most convenient route with the best financial outcome. For instance, an optometrist should refer a retinal detachment to a retinal specialist and not to a general ophthalmologist. While most ophthalmologists realise their limitations and will refer cases beyond their abilities, this is unfortunately not always the case.
Optometrists working in or near major centres and cities, should familiarise themselves with the local ophthalmologists with regards to each of their sub-specialities or particular fields of interest within the broad overall field of ophthalmology.
In South Africa today, there are no formal sub-specialities in ophthalmology (also known as super-specialities) as there are in the USA for example. Even vitreo-retinal surgery is not considered a separate discipline officially. Here are some of the informal sub-specialities available in South Africa today.
This is by far the most common group and cannot really be considered a “sub-speciality”. General ophthalmologists usually handle (or attempt to handle) all ophthalmological disorders except for vitreo-retinal surgery, complex orbital surgery, and various other rare and complex disorders and treatments.
These ophthalmologists have usually done a fellow-ship in this field in a formal institution overseas but not always. I know many excellent vitreo-retinal surgeons who have never done formal fellow-ships. Of course their main surgical work is repairing retinal detachments, retinal tears and holes, vitreous disorders, and posterior segment trauma. They are highly respected by cataract surgeons, who never know when a lens nucleus will be dropped into the vitreous during phaco, requiring their local friendly retinal surgeon to fish it out!
3.Medical retina specialists
These are ophthalmologists who specialise in disorders of the retina such as diabetic retinopathy, maculopathy, vessel occlusion, etc. They make use of intra-vitreal injections and laser treatment but not vitreo-retinal surgery.
4.Strabismologists and paediatric ophthalmologists
Paediatric ophthalmologists deal with babies and children under age 16 years. They are usually also experts in strabismus in both children and adults.
They often have a background in general neurology. They have often spent a few years in the academic neurology departments, while waiting to get into ophthalmology registrarship.
They deal mainly with lid and lacrimal issues. They have often spent time in academic plastic surgery departments before transferring over to ophthalmology. Some of them can do orbital surgery too, but this is more in the field of neurosurgery, ENT surgery, head and neck surgery, and maxillo-facial surgery.
They deal mainly with scarred corneas and are surgical experts in the field of keratoplasty, which has exploded recently with all the new partial keratoplasty techniques such as DALK and DSAEK. They are also experts in managing keratoconus and severe corneal ulcers.
8.Cataract and refractive surgeons
Almost all ophthalmologists do cataract surgery (which is also a type of refractive procedure), but few are interested and expert in purely refractive surgery such as PRK and lasik.
Almost all ophthalmologists are capable and willing to diagnose and treat glaucoma patients medically (with drops). Many general ophthalmologists also do a very good surgical drainage procedure such as a trabeculectomy. The glaucoma surgeon takes over when medical treatment, laser treatment, or initial surgical treatment fails. Complex drainage procedures are then needed and usually best done by a glaucoma expert.
They are rare specialists (I only know of one in the whole of Gauteng), who have a special interest in tumors and malignancies of the eye, adnexa, and orbit.
They are also rare and have an interest in uveitis, sclerites, auto-immune diseases, etc. They usually have a background in rheumatology, tropical medicine or internal medicine.
12.Ocular trauma specialists
They deal with serious ocular trauma involving the anterior segment such as penetrating injuries and severe chemical burns. Minor trauma can be handled by any ophthalmologist. Major trauma involving the posterior segment is handled by vitreo-retinal surgeons.
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